U.S. patent application number 15/005157 was filed with the patent office on 2016-05-19 for expandable spinal implant system and method.
The applicant listed for this patent is Warsaw Orthopedic, Inc.. Invention is credited to Charles A. Britt, Kyle A. Hess, David R. Kaes, Julien J. Prevost, Kelly W. Schlachter, Guobao Wei.
Application Number | 20160135962 15/005157 |
Document ID | / |
Family ID | 51531314 |
Filed Date | 2016-05-19 |
United States Patent
Application |
20160135962 |
Kind Code |
A1 |
Prevost; Julien J. ; et
al. |
May 19, 2016 |
EXPANDABLE SPINAL IMPLANT SYSTEM AND METHOD
Abstract
A spinal implant comprises a first member including a wall that
defines a first cavity and a second member including a wall
defining a second cavity. At least one first expandable bone graft
is disposable within the second cavity. The second member is
axially translatable relative to the first member between a first
configuration and a second, expanded configuration such that at
least a portion of the at least one first graft is disposed within
the first cavity and the first cavity includes a substantially void
portion. At least one second bone graft has a selective
configuration and dimension for disposal within the substantially
void portion. Systems and methods are disclosed.
Inventors: |
Prevost; Julien J.;
(Memphis, TN) ; Britt; Charles A.; (Southaven,
MS) ; Hess; Kyle A.; (Memphis, TN) ; Kaes;
David R.; (Toms River, NJ) ; Schlachter; Kelly
W.; (Mason, TN) ; Wei; Guobao; (Milltown,
NJ) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Warsaw Orthopedic, Inc. |
Warsaw |
IN |
US |
|
|
Family ID: |
51531314 |
Appl. No.: |
15/005157 |
Filed: |
January 25, 2016 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
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13801170 |
Mar 13, 2013 |
9271844 |
|
|
15005157 |
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Current U.S.
Class: |
623/17.11 |
Current CPC
Class: |
A61F 2002/30062
20130101; A61F 2002/2835 20130101; A61F 2/44 20130101; A61F
2002/30601 20130101; A61F 2/4465 20130101; A61F 2002/30092
20130101; A61F 2002/3055 20130101; A61F 2002/30841 20130101; A61F
2002/30733 20130101; A61F 2002/30593 20130101; A61F 2002/30405
20130101; A61F 2002/30235 20130101; A61F 2/4455 20130101; A61F
2002/30556 20130101; A61F 2002/30579 20130101 |
International
Class: |
A61F 2/44 20060101
A61F002/44 |
Claims
1. A spinal implant comprising: a first member including a wall
that defines a first cavity; a second member extending between a
first end and a second end and defining a longitudinal axis, the
second member including a wall defining a second cavity; at least
one first expandable bone graft disposable within the second
cavity; wherein the second member is disposable within the first
cavity and axially translatable relative to the first member
between a first configuration and a second, expanded configuration
such that at least a portion of the at least one first graft is
disposed within the first cavity and the first cavity includes a
substantially void portion; and at least one second bone graft
having a selective configuration and dimension for disposal within
the substantially void portion.
2. A spinal implant as recited in claim 1, wherein the at least one
first graft is expandable in at least an axial direction such that
the at least one first graft is expandable into the first
cavity.
3. A spinal implant as recited in claim 1, wherein the at least one
first graft is expandable in at least an axial direction such that
the at least one first graft is expandable into the first cavity
and a lateral direction.
4. A spinal implant as recited in claim 1, wherein the members are
expandable independent of the at least one first graft.
5. A spinal implant as recited in claim 1, wherein the at least one
second graft is expandable such that the at least one first graft,
the at least one second graft and the members are each
independently expandable.
6. A spinal implant as recited in claim 1, wherein the at least one
first graft is expandable between a first configuration and a
second configuration such that the at least one first graft engages
an inner surface of the wall of the second member and the inner
surface includes an expansion limit for at least a portion of the
expanded at least one first graft.
7. A spinal implant as recited in claim 1, wherein the at least one
first graft includes a cylindrical insert being selectively
configured and dimensioned for disposal within the second cavity
and expansion into the first cavity.
8. A spinal implant as recited in claim 1, wherein the at least one
second graft includes an insert having an oblong barrel shaped
cross section selectively configured and dimensioned for disposal
within the substantially void portion.
9. A spinal implant as recited in claim 1, wherein the at least one
second graft includes an insert having a cross section including
three straight sides and one curved side selectively configured and
dimensioned for disposal within the substantially void portion.
10. A spinal implant as recited in claim 1, wherein the at least
one first graft is disposable from a first configuration to a
second, expanded configuration upon exposure to liquid in vivo.
11. A spinal implant as recited in claim 1, wherein the at least
one first graft includes demineralized cancellous bone particles
and demineralized cortical bone particles, the at least one first
graft being expandable upon rehydration in vivo.
12. A spinal implant comprising: an outer body including a wall
having an inner surface that defines a chamber; an inner body
extending between a first end defining an opening and a second end
and defining a longitudinal axis, the second member including a
wall defining an axial channel; at least one cylindrical insert
comprising demineralized cancellous bone particles and
demineralized cortical bone particles, the at least one insert
being selectively configured and dimensioned for disposal within
the axial channel and expansion upon exposure to liquid in vivo
into the chamber; wherein the inner body is disposable within the
chamber and axially translatable relative to the outer body between
a first configuration and a second, expanded configuration such
that at least a portion of the at least one insert is disposed
within the chamber and the chamber includes a substantially void
portion; and bone graft having a selective configuration and
dimension for disposal within the substantially void portion.
13. A method for treating a spine, the method comprising the steps
of: providing a spinal implant comprising a first member including
a wall that defines a first cavity and a second member disposed
with the first member and defining a longitudinal axis, the second
member including a wall defining a second cavity; selecting at
least one first bone graft for disposal in the second cavity;
axially translating the second member relative to the first member
between a first configuration and a second, expanded configuration
such that at least a portion of the at least one first graft is
expanded within the first cavity and the first cavity includes a
substantially void portion; and selecting at least one second bone
graft having a selective configuration and dimension for disposal
within the substantially void portion.
14. A method as recited in claim 13, wherein the step of selecting
the at least one second bone graft includes selecting the
configuration and dimension of the at least one second bone graft
based on an expanded dimension of the members.
15. A method as recited in claim 13, wherein the step of selecting
the at least one second bone graft includes selecting the
configuration and dimension of the at least one second bone graft
based on a dimension of the substantially void portion.
16. A method as recited in claim 13, wherein the at least one
second bone graft includes a plurality of independently dimensioned
inserts.
17. A spinal implant as recited in claim 1, wherein the members are
expandable independent of the at least one first graft.
18. A spinal implant as recited in claim 1, wherein the at least
one second graft is expandable such that the at least one first
graft, the at least one second graft and the members are each
independently expandable.
19. A spinal implant as recited in claim 1, wherein the at least
one first graft is disposable from a first configuration to a
second, expanded configuration upon exposure to liquid in vivo.
20. A spinal implant as recited in claim 1, wherein the at least
one first graft includes demineralized cancellous bone particles
and demineralized cortical bone particles, the at least one first
graft being expandable upon rehydration in vivo.
Description
TECHNICAL FIELD
[0001] The present disclosure generally relates to medical devices
for the treatment of musculoskeletal disorders, and more
particularly to a surgical system that includes an expandable
spinal implant and a method for treating a spine.
BACKGROUND
[0002] Spinal disorders such as degenerative disc disease, disc
herniation, osteoporosis, spondylolisthesis, stenosis, scoliosis
and other curvature abnormalities, kyphosis, tumor, and fracture
may result from factors including trauma, disease and degenerative
conditions caused by injury and aging. Spinal disorders typically
result in symptoms including pain, nerve damage, and partial or
complete loss of mobility.
[0003] Non-surgical treatments, such as medication, rehabilitation
and exercise can be effective, however, may fail to relieve the
symptoms associated with these disorders. Surgical treatment of
these spinal disorders includes fusion, fixation, corpectomy,
discectomy, laminectomy and implantable prosthetics. In procedures,
such as, for example, corpectomy and discectomy, fusion and
fixation treatments may be performed that employ implants to
restore the mechanical support function of vertebrae. This
disclosure describes an improvement over these prior art
technologies.
SUMMARY
[0004] In one embodiment, a spinal implant is provided. The spinal
implant comprises a first member including a wall that defines a
first cavity. A second member extends between a first end and a
second end and defines a longitudinal axis. The second member
includes a wall defining a second cavity. At least one first
expandable bone graft is disposable within the second cavity. The
second member is disposable within the first cavity and axially
translatable relative to the first member between a first
configuration and a second, expanded configuration such that at
least a portion of the at least one first graft is disposed within
the first cavity and the first cavity includes a substantially void
portion. At least one second bone graft has a selective
configuration and dimension for disposal within the substantially
void portion. In some embodiments, systems and methods are
disclosed.
BRIEF DESCRIPTION OF THE DRAWINGS
[0005] The present disclosure will become more readily apparent
from the specific description accompanied by the following
drawings, in which:
[0006] FIG. 1 is a plan view of components of one embodiment of a
surgical system in accordance with the principles of the present
disclosure;
[0007] FIG. 2 is a plan view of the components shown in FIG. 1;
[0008] FIG. 3 is a plan view of the components shown in FIG. 1;
[0009] FIG. 4 is a plan view of the components shown in FIG. 1;
[0010] FIGS. 5-15 are perspective views of components of
embodiments of a surgical system in accordance with the principles
of the present disclosure;
[0011] FIG. 16 is a perspective view of components of one
embodiment of a surgical system in accordance with the principles
of the present disclosure disposed with vertebrae; and
[0012] FIG. 17 is a perspective view of the components shown in
FIG. 16 disposed with vertebrae.
DETAILED DESCRIPTION
[0013] The exemplary embodiments of the surgical system and related
methods of use disclosed are discussed in terms of medical devices
for the treatment of musculoskeletal disorders and more
particularly, in terms of a surgical system that includes an
expandable spinal implant and a method for treating a spine. In one
embodiment, the system comprises a spinal implant including an
interbody fusion device. In one embodiment, the system comprises a
spinal implant including an expandable cage. In one embodiment, the
spinal implant includes expandable pre-shaped demineralized
allograft. In one embodiment, the system comprises a spinal implant
including an in vivo expandable corpectomy cage. In some
embodiments, the system includes bone graft, such as, for example,
specially formed and cut versions of an allograft material
configured to fit and conform to an interior space of a corpectomy
cage. In other embodiments, the bone graft may include other
materials, including but not limited to: shaped xenograft material;
shaped biological materials; shaped/expandable polymer-bone
composites; allograft material; and combinations thereof.
[0014] In one embodiment, the system comprises an expandable spinal
implant that is employed with a method that includes the steps of
pre-packing and post-packing the spinal implant with bone graft,
such as, for example, 100% demineralized cortical and cancellous
allograft. In one embodiment, the method includes the steps of
expanding the spinal implant. In one embodiment, the method
includes the steps of rehydratation of the allograft in-vivo, such
that the allograft expands to fill any void(s) created by the
expansion of the spinal implant.
[0015] In one embodiment, one or all of the components of the
surgical system are disposable, peel-pack, pre-packed sterile
devices used with an implant. One or all of the components of the
surgical system may be reusable. The surgical system may be
configured as a kit with multiple sized and configured
components.
[0016] In some embodiments, the present disclosure may be employed
to treat spinal disorders such as, for example, degenerative disc
disease, disc herniation, osteoporosis, spondylolisthesis,
stenosis, scoliosis and other curvature abnormalities, kyphosis,
tumor and fractures. In some embodiments, the present disclosure
may be employed with other osteal and bone related applications,
including those associated with diagnostics and therapeutics. In
some embodiments, the disclosed surgical system and methods may be
alternatively employed in a surgical treatment with a patient in a
prone or supine position, and/or employ various surgical approaches
to the spine, including anterior, posterior, posterior mid-line,
direct lateral, postero-lateral, and/or antero-lateral approaches,
and in other body regions. The present disclosure may also be
alternatively employed with procedures for treating the lumbar,
cervical, thoracic, sacral and pelvic regions of a spinal column.
The system and methods of the present disclosure may also be used
on animals, bone models and other non-living substrates, such as,
for example, in training, testing and demonstration.
[0017] The present disclosure may be understood more readily by
reference to the following detailed description of the embodiments
taken in connection with the accompanying drawing figures, which
form a part of this disclosure. It is to be understood that this
application is not limited to the specific devices, methods,
conditions or parameters described and/or shown herein, and that
the terminology used herein is for the purpose of describing
particular embodiments by way of example only and is not intended
to be limiting. Also, as used in the specification and including
the appended claims, the singular forms "a," "an," and "the"
include the plural, and reference to a particular numerical value
includes at least that particular value, unless the context clearly
dictates otherwise. Ranges may be expressed herein as from "about"
or "approximately" one particular value and/or to "about" or
"approximately" another particular value. When such a range is
expressed, another embodiment includes from the one particular
value and/or to the other particular value. Similarly, when values
are expressed as approximations, by use of the antecedent "about,"
it will be understood that the particular value forms another
embodiment. It is also understood that all spatial references, such
as, for example, horizontal, vertical, top, upper, lower, bottom,
left and right, are for illustrative purposes only and can be
varied within the scope of the disclosure. For example, the
references "upper" and "lower" are relative and used only in the
context to the other, and are not necessarily "superior" and
"inferior".
[0018] Further, as used in the specification and including the
appended claims, "treating" or "treatment" of a disease or
condition refers to performing a procedure that may include
administering one or more drugs to a patient (human, normal or
otherwise or other mammal), employing implantable devices, and/or
employing instruments that treat the disease, such as, for example,
microdiscectomy instruments used to remove portions bulging or
herniated discs and/or bone spurs, in an effort to alleviate signs
or symptoms of the disease or condition. Alleviation can occur
prior to signs or symptoms of the disease or condition appearing,
as well as after their appearance. Thus, treating or treatment
includes preventing or prevention of disease or undesirable
condition (e.g., preventing the disease from occurring in a
patient, who may be predisposed to the disease but has not yet been
diagnosed as having it). In addition, treating or treatment does
not require complete alleviation of signs or symptoms, does not
require a cure, and specifically includes procedures that have only
a marginal effect on the patient. Treatment can include inhibiting
the disease, e.g., arresting its development, or relieving the
disease, e.g., causing regression of the disease. For example,
treatment can include reducing acute or chronic inflammation;
alleviating pain and mitigating and inducing re-growth of new
ligament, bone and other tissues; as an adjunct in surgery; and/or
any repair procedure. Also, as used in the specification and
including the appended claims, the term "tissue" includes soft
tissue, ligaments, tendons, cartilage and/or bone unless
specifically referred to otherwise.
[0019] In some embodiments, the system of the present disclosure
comprises a spinal implant that includes bone graft, for example,
osteograft. As used in the specification and including the appended
claims of the present disclosure, the term "bone graft" includes
materials that may include both synthetic and natural bone. In some
embodiments, natural bone may be taken from the graft recipient,
for example, autograft, or may be taken from another source, for
example, allograft, such as a cadaver, or can be xenograft, for
example, bovine.
[0020] In some embodiments, osteoconduction and osteoinduction both
contribute to bone formation. Osteoconductivity provides a
structural framework or microscopic and macroscopic scaffolding for
cells and cellular materials that are involved in bone formation,
for example, osteoclasts, osteoblasts, vasculature and mesenchymal
cells. Osteoinductive material stimulates differentiation of host
mesenchymal cells into chondroblasts and osteoblasts. Natural bone
allograft materials can comprise either cortical or cancellous
bone. In some embodiments, allografts can comprise mammalian
cadaver bone treated to remove all soft tissue, including marrow
and blood, and then textured to form a multiplicity of holes of
selected size, spacing, and depth. In some embodiments, the
textured bone section can be immersed and demineralized, for
example, in a dilute acid bath.
[0021] In some embodiments, allografts are formed of organic bone
matrix with perforations that extend from one surface, through the
matrix, to the other surface to provide continuous channels between
opposite surfaces. In some embodiments, partially-demineralized
cortical bone constructs may be surface-demineralized to prepare
the graft to be soaked in bone growth-promoting substances such as
bone morphogenetic protein (BMP).
[0022] The following discussion includes a description of a
surgical system and related methods of employing the surgical
system in accordance with the principles of the present disclosure.
Alternate embodiments are also disclosed. Reference will now be
made in detail to the exemplary embodiments of the present
disclosure, which are illustrated in the accompanying figures.
Turning now to FIGS. 1-4, there is illustrated components of a
surgical system, such as, for example, a spinal implant system 10
in accordance with the principles of the present disclosure.
[0023] The components of spinal implant system 10 can be fabricated
from biologically acceptable materials suitable for medical
applications, including metals, synthetic polymers, ceramics and
bone material and/or their composites, depending on the particular
application and/or preference of a medical practitioner. For
example, the components of spinal implant system 10, individually
or collectively, can be fabricated from materials such as stainless
steel alloys, commercially pure titanium, titanium alloys, Grade 5
titanium, super-elastic titanium alloys, cobalt-chrome alloys,
stainless steel alloys, superelastic metallic alloys (e.g.,
Nitinol, super elasto-plastic metals, such as GUM METAL.RTM.
manufactured by Toyota Material Incorporated of Japan), ceramics
and composites thereof such as calcium phosphate (e.g., SKELITE.TM.
manufactured by Biologix Inc.), thermoplastics such as
polyaryletherketone (PAEK) including polyetheretherketone (PEEK),
polyetherketoneketone (PEKK) and polyetherketone (PEK), carbon-PEEK
composites, PEEK-BaSO.sub.4 polymeric rubbers, polyethylene
terephthalate (PET), fabric, silicone, polyurethane,
silicone-polyurethane copolymers, polymeric rubbers, polyolefin
rubbers, hydrogels, semi-rigid and rigid materials, elastomers,
rubbers, thermoplastic elastomers, thermoset elastomers,
elastomeric composites, rigid polymers including polyphenylene,
polyamide, polyimide, polyetherimide, polyethylene, epoxy, bone
material including autograft, allograft, xenograft or transgenic
cortical and/or corticocancellous bone, and tissue growth or
differentiation factors, partially resorbable materials, such as,
for example, composites of metals and calcium-based ceramics,
composites of PEEK and calcium based ceramics, composites of PEEK
with resorbable polymers, totally resorbable materials, such as,
for example, calcium based ceramics such as calcium phosphate,
tri-calcium phosphate (TCP), hydroxyapatite (HA)-TCP, calcium
sulfate, or other resorbable polymers such as polyaetide,
polyglycolide, polytyrosine carbonate, polycaroplaetohe and their
combinations. Various components of spinal implant system 10 may
have material composites, including the above materials, to achieve
various desired characteristics such as strength, rigidity,
elasticity, compliance, biomechanical performance, durability and
radiolucency or imaging preference. The components of spinal
implant system 10, individually or collectively, may also be
fabricated from a heterogeneous material such as a combination of
two or more of the above-described materials. The components of
spinal implant system 10 may be monolithically formed, integrally
connected or include fastening elements and/or instruments, as
described herein.
[0024] Spinal implant system 10 is employed, for example, with a
minimally invasive procedure, including percutaneous techniques,
mini-open and open surgical techniques to deliver and introduce
instrumentation and/or an implant, such as, for example, a
corpectomy implant, at a surgical site within a body of a patient,
for example, a section of a spine. In some embodiments, spinal
implant system 10 may be employed with surgical procedures, such
as, for example, corpectomy and discectomy, which include fusion
and/or fixation treatments that employ implants, in accordance with
the principles of the present disclosure, to restore the mechanical
support function of vertebrae.
[0025] Spinal implant system 10 includes an implant, such as, for
example, a corpectomy cage 12 having a member, such as, for
example, an outer body 14. Body 14 has a tubular configuration.
Body 14 is substantially cylindrical and extends between an end 16
and an end 18 and defines a longitudinal axis a. End 16 defines a
substantially planar surface. End 18 defines a substantially planar
surface including fixation elements, such as, for example, spikes
19 configured to engage vertebral tissue. In some embodiments, end
16 and/or end 18 can include a surface that may be rough, textured,
porous, semi-porous, dimpled and/or polished such that it
facilitates engagement with tissue. In some embodiments, both or
only one of ends 16, 18 may engage tissue to provide treatment. In
some embodiments, the vertebral tissue may include intervertebral
tissue, endplate surfaces and/or cortical bone.
[0026] Body 14 includes a tubular wall 20 that includes an inner
surface 22. Surface 22 defines an axial cavity 24 extending between
ends 16, 18. In some embodiments, wall 20 defines a cylindrical
cross-section of cavity 24. In some embodiments, the cross-section
geometry of cavity 24 may have various configurations, such as, for
example, round, oval, oblong, triangular, polygonal having planar
or arcuate side portions, irregular, uniform, non-uniform,
consistent, variable, horseshoe shape, U-shape or kidney bean
shape. In some embodiments, surface 22 is smooth or even. In some
embodiments, surface 22 may be rough, textured, porous,
semi-porous, dimpled and/or polished.
[0027] Wall 20 defines a lateral opening 26 that communicates with
cavity 24. Opening 26 is configured to provide access to cavity 24.
In one embodiment, opening 26 facilitates delivery and/or
introduction of an agent and/or an implant, such as, for example,
bone graft and/or other materials, as described herein, into cavity
24. In some embodiments, opening 26 may have various
configurations, such as, for example, circular, oval, oblong,
triangular, rectangular, polygonal, planar side(s), arcuate
side(s), irregular, uniform, non-uniform, offset, staggered,
variable, U-shape, kidney bean shape and/or multiple openings.
[0028] Wall 20 defines openings 28 configured to facilitate
delivery and/or introduction of an agent, bone graft and/or other
materials, as described herein, into cavity 24, for employment in a
fixation or fusion treatment used for example, in connection with a
corpectomy. In one embodiment, the agent may include therapeutic
polynucleotides or polypeptides and bone growth promoting material,
which can be packed or otherwise disposed on or about the surfaces
of the components of spinal implant system 10, including cage 12.
The agent may also include biologically active agents, for example,
biologically active agents coated onto the exterior and/or interior
of cage 12 and/or applied thereto for gradual release such as by
blending in a bioresorbable polymer that releases the biologically
active agent or agents in an appropriate time dependent fashion as
the polymer degrades within the patient. Suitable biologically
active agents include, for example, BMP and cytokines. In some
embodiments, openings 28 may have various configurations, such as,
for example, those described herein.
[0029] The planar surface of end 16 defines an opening 30 that
communicates with cavity 24. Opening 30 has a rectangular
configuration and is configured to provide access to cavity 24.
Opening 30 facilitates disposal of a member, such as, for example,
inner body 32 with cavity 24, as described herein. The planar
surface of end 18 defines an opening 34 that communicates with
cavity 24. Opening 34 has a rectangular configuration and is
configured to provide access to cavity 24. In some embodiments,
opening 30 and/or opening 34 may have various configurations, such
as, for example, those described herein.
[0030] Body 32 has a tubular configuration. Body 32 is
substantially rectangular and extends between an end 36 and an end
38 and extends along longitudinal axis a. End 36 defines a
substantially planar surface including fixation elements, such as,
for example, spikes 37 configured to engage vertebral tissue. End
38 defines a substantially planar surface. In some embodiments, end
36 can include a surface that may be rough, textured, porous,
semi-porous, dimpled and/or polished such that it facilitates
engagement with tissue. In other embodiments, body 32 may have a
variety of alternative cross-sectional configurations including,
but not limited to: round; oval; "U" or "C" shaped; and
combinations thereof.
[0031] Body 32 includes a tubular wall 40. Wall 40 includes an
inner surface 42 that defines an axial cavity 44 extending between
ends 36, 38. In some embodiments, wall 40 defines a rectangular
cross-section of cavity 44. In some embodiments, the cross-section
geometry of cavity 44 may have various configurations, such as, for
example, those described herein. In some embodiments, surface 42 is
smooth or even. In some embodiments, surface 42 may be rough,
textured, porous, semi-porous, dimpled and/or polished.
[0032] Wall 40 defines lateral openings 46 that communicate with
cavity 44. Openings 46 are configured to provide access to cavity
44. In one embodiment, openings 46 facilitate delivery and/or
introduction of an agent, as described herein, into cavity 44. In
some embodiments, openings 46 may have various configurations, such
as, for example, those described herein.
[0033] The planar surface of end 36 defines an opening 48 that
communicates with cavity 44. Opening 48 has a circular
configuration and is configured to provide access to cavity 44. In
one embodiment, opening 48 facilitates delivery and/or introduction
of an agent and/or an implant, such as, for example, bone graft
and/or other materials, as described herein, with cavity 44. The
planar surface of end 38 defines an opening 50 that communicates
with cavity 44 and cavity 24. Opening 50 has a rectangular
configuration and is configured to provide access to cavity 44 and
cavity 24. In some embodiments, opening 48 and/or opening 50 may
have various configurations, such as, for example, those described
herein.
[0034] Spinal implant system 10 includes a bone graft implant, such
as, for example, an expandable insert 52. Insert 52 is configured
for disposal within cavity 44. Insert 52 comprises expandable bone
graft material, see, for example, the implants and materials
described in commonly owned US Patent Application Publication No.
2008/0091270 to Miller et al., the entire contents of which being
hereby incorporated by referenced herein. For example, in one
embodiment, insert 52 is expandable from a first configuration to a
second, expanded configuration upon exposure to liquid in vivo. In
some embodiments, such liquid includes body fluids of a patient. In
some embodiments, insert 52 includes demineralized cancellous bone
particles and demineralized cortical bone particles such that
insert 52 is expandable upon rehydration in vivo. In some
embodiments, insert 52 comprises bone graft, such as, for example,
those materials described herein.
[0035] In some embodiments, insert 52 is expandable within cavity
44 and/or through opening 50 into cavity 24. In some embodiments,
insert 52 is expandable in one or both axial directions along axis
a, and/or in a transverse direction, including angular orientations
and perpendicular relative to axis a. In some embodiments, bodies
14, 32 are expandable independent of insert 52. In some
embodiments, insert 52 is expandable between a first, non-expanded
configuration, as shown in FIG. 1, and a second, expanded
configuration, as shown in FIG. 4, such that insert 52 engages
inner surface 22. Inner surface 22 includes an expansion limit for
lateral expansion of insert 52.
[0036] Cage 12 is selectively movable between a first
configuration, such as, for example, as shown in FIG. 1, and a
second configuration, such as, for example, as shown in FIG. 4, to
restore vertebral spacing and provide distraction and/or restore
mechanical support function of vertebrae. In some embodiments,
opening 30 facilitates axial translation of body 32 relative to
body 14 for selective expansion and/or contraction of bodies 14, 32
between a collapsed and/or nested configuration, as shown in FIG.
16, and an expanded configuration, as shown in FIG. 17. In some
embodiments, cage 12 is disposed in a collapsed, telescopic
configuration for delivery and implantation adjacent a surgical
site and bodies 14, 32 are expanded in vivo. In some embodiments,
cage 12 and/or the bone graft inserts described herein can be
expanded prior to implantation adjacent a surgical site. In some
embodiments, cage 12 can be disposed to engage adjacent vertebral
soft tissue and bone surfaces to restore height and provide support
in place of removed vertebrae and/or intervertebral tissue.
[0037] In one embodiment, expansion and/or contraction of cage 12
is facilitated by engagement of respective helical gear surfaces of
bodies 14, 32 such that relative rotation of bodies 14, 32 causes
axial translation of body 32 relative to body 14. In one
embodiment, expansion and/or contraction of cage 12 is facilitated
by engagement of a tool with one of bodies 14, 32 to cause axial
translation of body 32 relative to body 14. In one embodiment,
expansion and/or contraction of cage 12 is facilitated by free hand
manipulation of bodies 14, 32 to cause axial translation of body 32
relative to body 14. In one embodiment, expansion and/or
contraction of cage 12 is facilitated by engagement of respective
pinion gear and rack surfaces of bodies 14, 32 to cause axial
translation of body 32 relative to body 14. In some embodiments,
expansion and/or contraction of cage 12 is facilitated by various
configurations, such as, for example, mechanical, pneumatic and/or
hydraulic components disposed with the surfaces of cage 12, for
example, disposed within cavity 24. In some embodiments, cage 12 is
configured for continuous expansion, which includes incremental
expansion. In some embodiments, incremental expansion may include
discrete increments of a particular linear dimension. In some
embodiments, the increments of linear dimension may include a range
of approximately 0.1-1.0 mm.
[0038] Insert 52 is introduced through opening 48, as shown in FIG.
1, and disposed within cavity 44 and body 32 is disposed within
cavity 24, as shown in FIG. 2. Body 32 is axially translatable
relative to body 14 for selective expansion and/or contraction
between a collapsed and/or nested configuration, as shown in FIG.
2, and an expanded configuration, as shown in FIG. 3. Bodies 14, 32
are expanded such that body 32 and at least a portion of insert 52
are disposed within cavity 24 and cavity 24 includes a
substantially void portion 54, as shown in FIGS. 3 and 4. In some
embodiments, portion 54 can include one or a plurality of open
spaces and/or non-occupied volumes, which may be continuous or
non-continuous, uniform or non-uniform, and/or variously
configured, such as, for example, those alternatives described
herein.
[0039] In one embodiment, a portion of insert 52 is disposed within
cavity 24 due to disposal of body 32 within cavity 24. In one
embodiment, a portion of insert 52 is disposed within cavity 24 due
to expansion of insert 52 through opening 50 into cavity 24. In one
embodiment, one or all of the components of cage 12 can be expanded
and cavity 24 does not include a void portion, for example, such
that insert 52 substantially occupies the space of cavity 24.
[0040] Spinal implant system 10 includes a bone graft implant, such
as, for example, an expandable insert 56, as shown in FIG. 1. In
some embodiments, insert 56 is selectively configured and
dimensioned for disposal within void portion 54. Insert 56
comprises expandable bone graft material, see, for example, the
implants and materials described in commonly owned US Patent
Application Publication No. 2008/0091270. For example, in one
embodiment, insert 56 is expandable from a first configuration, as
shown in FIG. 3, to a second, expanded configuration, as shown in
FIG. 4, upon exposure to liquid in vivo. In some embodiments, such
liquid includes body fluids of a patient. In some embodiments,
insert 56 includes demineralized cancellous bone particles and
demineralized cortical bone particles such that insert 56 is
expandable upon rehydration in vivo. In some embodiments, insert 56
comprises bone graft, such as, for example, those materials
described herein.
[0041] In some embodiments, one or a plurality of inserts 56 are
selectively disposed based on the number, configuration and/or
dimension of the one or plurality of open spaces or non-occupied
volumes of portion 54. In some embodiments, insert 56 is expandable
in one or both axial directions along axis a, and/or in a
transverse direction, including angular orientations and
perpendicular relative to axis a. In some embodiments, insert 56 is
expandable independent of bodies 14, 32 and/or insert 52.
[0042] In some embodiments, as shown in FIGS. 5-15, spinal implant
system 10 includes insert 52 and/or insert 56 having various
configurations and dimensions. In some embodiments, various
configurations of inserts 52, 56 may be used to maintain position
of inserts 52, 56 with respect to bodies 14, 32, for example. In
some embodiments, the expanded diameter d1, shown in FIGS. 5 and 6,
may be used to reduce the risk of undesirable or inadvertent
placement, expulsion from bodies 14, 32 and/or loss of inserts 52,
56 during manipulation and insertion of cage 12 and to maintain
position of inserts 52, 56 with respect to bodies 14, 32 during in
vivo expansion of cage 12. Other complementary designs of the
insert/cage interface may be used to maintain position of the
inserts with respect to the bodies, including, but not limited to
counterbores, keyways, and combinations thereof at one or more
locations.
[0043] In one embodiment, as shown in FIG. 5, insert 52 includes a
cylinder having a height h of 30 mm and a diameter d of 4.3 mm,
which extends between a planar end face and a frusto-conical end
face having a diameter d1 of 9.2 mm. In one embodiment, as shown in
FIG. 6, insert 52 includes a cylinder having a height h of 30 mm
and a diameter d of 7.5 mm, which extends between a planar end face
and a frusto-conical end face having a diameter d1 of 12.4 mm.
[0044] In one embodiment, as shown in FIG. 7, insert 56 includes an
oblong, barrel shaped configuration having a width w of 11 mm, a
height h of 11 mm, and planar end faces having a depth d of 5.5 mm.
In one embodiment, as shown in FIG. 8, insert 56 includes an
oblong, barrel shaped configuration having a width w of 15 mm, a
height h of 11 mm, and planar end faces having a depth d of 5.5 mm.
In one embodiment, as shown in FIG. 9, insert 56 includes an
oblong, barrel shaped configuration having a width w of 21 mm, a
height h of 11 mm, and planar end faces having a depth d of 5.5
mm.
[0045] In one embodiment, as shown in FIG. 10, insert 56 includes a
cylinder having a height h of 6 mm and extending between planar end
faces having a diameter d of 5.2 mm. In one embodiment, as shown in
FIG. 11, insert 56 includes a cylinder having a height h of 9 mm
and extending between planar end faces having a diameter d of 5.2
mm.
[0046] In one embodiment, as shown in FIG. 12, insert 56 includes a
three dimensional geometrical shape with three linear sides
connected by an arcuate side, which includes an 8 mm base b, 6 mm
sides s and a depth d of 6 mm. In one embodiment, as shown in FIG.
13, insert 56 includes a three dimensional geometrical shape with
three linear sides connected by an arcuate side, which includes an
8 mm base b, 9 mm sides s and a depth d of 6 mm. In one embodiment,
as shown in FIG. 14, insert 56 includes a three dimensional
geometrical shape with three linear sides connected by an arcuate
side, which includes a 9.5 mm base b, 6 mm sides s and a depth d of
8.5 mm. In one embodiment, as shown in FIG. 15, insert 56 includes
a three dimensional geometrical shape with three linear sides
connected by an arcuate side, which includes an 9.5 mm base b, 9 mm
sides s and a depth d of 8.5 mm.
[0047] Referring to FIGS. 16 and 17, in assembly, operation and
use, spinal implant system 10 including cage 12 and insert 52
and/or insert 56 disposed therewith, similar to that described with
regard to FIGS. 1-15, is employed with a surgical procedure, such
as, for example, a lumbar corpectomy for treatment of a spine of a
patient including vertebrae V. Spinal implant system 10 may also be
employed with other surgical procedures, such as, for example,
discectomy, laminectomy, fusion, laminotomy, laminectomy, nerve
root retraction, foramenotomy, facetectomy, decompression, spinal
nucleus or disc replacement and bone graft and implantable
prosthetics including plates, rods, and bone engaging fasteners for
securement of cage 12.
[0048] Spinal implant system 10 is employed with a lumbar
corpectomy including surgical arthrodesis, such as, for example,
fusion to immobilize a joint for treatment of an applicable
condition or injury of an affected section of a spinal column and
adjacent areas within a body. For example, vertebrae V includes a
vertebra V1 and a vertebra V2. A diseased and/or damaged vertebra
and intervertebral discs are disposed between the vertebrae V1 and
V2. In some embodiments, spinal implant system 10 is configured for
insertion with a vertebral space to space apart articular joint
surfaces, provide support and maximize stabilization of vertebrae
V.
[0049] In use, to treat the affected section of vertebrae V, a
medical practitioner obtains access to a surgical site including
vertebrae V in any appropriate manner, such as through incision and
retraction of tissues. In some embodiments, system 10 may be used
in any existing surgical method or technique including open
surgery, mini-open surgery, minimally invasive surgery and
percutaneous surgical implantation, whereby vertebrae V is accessed
through a mini-incision, or sleeve that provides a protected
passageway to the area. Once access to the surgical site is
obtained, corpectomy is performed for treating the spine disorder.
The diseased and/or damaged portion of vertebrae V, and diseased
and/or damaged intervertebral discs are removed to create a
vertebral space S.
[0050] A preparation instrument (not shown) is employed to remove
disc tissue, fluids, adjacent tissues and/or bone, and scrape
and/or remove tissue from endplate surfaces E1 of vertebra V1
and/or endplate surface E2 of vertebra V2. Cage 12 is provided,
similar to those described herein, to promote new bone growth and
fusion to treat the affected section of vertebrae V.
[0051] Cage 12 is disposed in a collapsed configuration, as shown
in FIG. 16, for delivery and implantation adjacent a surgical site.
Insert 52 is introduced through opening 48 and disposed within
cavity 44 and body 32 is disposed within cavity 24. Cage 12 is
delivered to the surgical site adjacent vertebrae V with a delivery
instrument (not shown) including a driver via the protected
passageway for the arthrodesis treatment. The driver delivers cage
12 into the prepared vertebral space S, between vertebra V1 and
vertebra V2. Cage 12 is manipulated such that end 18 engages
endplate surface E2. A gripping surface, including spikes 19, of
end 18 penetrates and fixes with endplate surface E2.
[0052] Body 32 is axially translated relative to body 14 for
selective expansion in vivo to an expanded configuration, as shown
in FIG. 17, and described herein. Bodies 14, 32 are expanded such
that body 32 and a portion of insert 52 are disposed within cavity
24 and cavity 24 includes portion 54. As such, cage 12 expands
within vertebral space S and end 16 engages endplate surface E1. A
gripping surface, including spikes 37, of end 36 penetrates and
fixes with endplate surface E1.
[0053] In one embodiment, the configuration and dimension of
portion 54 is determined, calculated or otherwise selected, which
may include factors such as the number of open spaces and/or
non-occupied volumes, geometry and size, such that one or a
plurality of inserts 56 are selectively configured and dimensioned
for disposal within portion 54. Upon such determination, insert(s)
56 is disposed with portion 54. In one embodiment, insert 52
occupies cavity 24 such that no insert 56 is employed. In some
embodiments, insert 52 is pre-packed with cage 12 prior to
implantation at the surgical site adjacent vertebrae V and insert
56 is post-packed with implanted cage 12 in vivo. In some
embodiments, cage 12 is pre-packed insert 52 only such that insert
56 is not post-packed with cage 12. In some embodiments, various
combinations of insert(s) 52 and insert(s) 56 may be disposed with
cage 12, for example, as described below.
[0054] In one example, cage 12 has a mean diameter of 13 mm and is
pre-packed with an insert 52, similar those shown in FIGS. 5 and 6.
The 13 mm cage can include various alternate height dimensions, for
example, a collapsed height of 16 mm that can be expanded to a
height of 19 mm, a collapsed height of 19 mm that can be expanded
to a height of 23 mm, a collapsed height of 22 mm that can be
expanded to a height of 27 mm, a collapsed height of 26 mm that can
be expanded to a height of 35 mm, a collapsed height of 32 mm that
can be expanded to a height of 46 mm, and a collapsed height of 41
mm that can be expanded to a height of 59 mm. The 13 mm cage is not
post-packed with insert 56.
[0055] In one example, cage 12 has a mean diameter of 16 mm and is
pre-packed with an insert 52, similar those shown in FIGS. 5 and 6.
The 16 mm cage can include various alternate height dimensions, for
example, a collapsed height of 17 mm that can be expanded to a
height of 20 mm, a collapsed height of 20 mm that can be expanded
to a height of 25 mm, and a collapsed height of 23 mm that can be
expanded to a height of 29 mm. In this example, the 16 mm cage is
not post-packed with insert 56.
[0056] In one example, cage 12 has a mean diameter of 16 mm, and is
pre-packed with an insert 52, similar those shown in FIGS. 5 and 6,
and has a collapsed height of 28 mm that can be expanded in a range
to a height of 36 mm. In this example, for expansion in a range of
28 mm to 34 mm, the 16 mm cage is not post-packed with insert 56.
In this example, for expansion in a range of 35 mm to 36 mm, the 16
mm cage is post-packed with insert 56, as shown in FIG. 10.
[0057] In one example, cage 12 has a mean diameter of 16 mm, is
pre-packed with an insert 52, similar those shown in FIGS. 5 and 6,
and has a collapsed height of 33 mm that can be expanded in a range
to a height of 45 mm. In this example, for expansion in a range of
33 mm to 40 mm, the 16 mm cage is not post-packed with insert 56.
In this example, for expansion in a range of 41 mm to 45 mm, the 16
mm cage is post-packed with insert 56, as shown in FIG. 10.
[0058] In one example, cage 12 has a mean diameter of 16 mm, is
pre-packed with an insert 52, similar those shown in FIGS. 5 and 6,
and has a collapsed height of 41 mm that can be expanded in a range
to a height of 57 mm. In this example, for expansion in a range of
41 mm to 48 mm, the 16 mm cage is not post-packed with insert 56.
In this example, for expansion in a range of 49 mm to 52 mm, the 16
mm cage is post-packed with insert 56, as shown in FIG. 10. In this
example, for expansion in a range of 53 mm to 57 mm, the 16 mm cage
is post-packed with insert 56, as shown in FIG. 11.
[0059] In one example, cage 12 has a mean diameter of 19 mm and is
pre-packed with an insert 52, similar those shown in FIGS. 5 and 6.
The 19 mm cage can include various alternate height dimensions, for
example, a collapsed height of 19 mm that can be expanded to a
height of 23 mm, and a collapsed height of 23 mm that can be
expanded to a height of 29 mm. In this example, the 19 mm cage is
not post-packed with insert 56.
[0060] In one example, cage 12 has a mean diameter of 19 mm, is
pre-packed with an insert 52, similar those shown in FIGS. 5 and 6,
and has a collapsed height of 28 mm that can be expanded in a range
to a height of 39 mm. In this example, for expansion in a range of
28 mm to 35 mm, the 19 mm cage is not post-packed with insert 56.
In this example, for expansion in a range of 36 mm to 39 mm, the 19
mm cage is post-packed with insert 56, as shown in FIG. 14.
[0061] In one example, cage 12 has a mean diameter of 19 mm, is
pre-packed with an insert 52, similar those shown in FIGS. 5 and 6,
and has a collapsed height of 36 mm that can be expanded in a range
to a height of 51 mm. In this example, for expansion in a range of
36 mm to 43 mm, the 19 mm cage is not post-packed with insert 56.
In this example, for expansion in a range of 44 mm to 51 mm, the 19
mm cage is post-packed with insert 56, as shown in FIG. 14.
[0062] In one example, cage 12 has a mean diameter of 19 mm, is
pre-packed with an insert 52, similar those shown in FIGS. 5 and 6,
and has a collapsed height of 47 mm that can be expanded in a range
to a height of 73 mm. In this example, for expansion in a range of
47 mm to 54 mm, the 19 mm cage is not post-packed with insert 56.
In this example, for expansion in a range of 55 mm to 61 mm, the 19
mm cage is post-packed with insert 56, as shown in FIG. 14. In this
example, for expansion in a range of 62 mm to 68 mm, the 19 mm cage
is post-packed with two inserts 56, as shown in FIG. 14. In this
example, for expansion in a range of 69 mm to 73 mm, the 19 mm cage
is post-packed with three inserts 56, as shown in FIG. 14.
[0063] In one example, cage 12 has a mean diameter of 19 mm, is
pre-packed with an insert 52, similar those shown in FIGS. 5 and 6,
and has a collapsed height of 69 mm that can be expanded in a range
to a height of 108 mm. In this example, for expansion in a range of
69 mm to 76 mm, the 19 mm cage is not post-packed with insert 56.
In this example, for expansion in a range of 77 mm to 82 mm, the 19
mm cage is post-packed with insert 56, as shown in FIG. 14. In this
example, for expansion in a range of 83 mm to 89 mm, the 19 mm cage
is post-packed with two inserts 56, as shown in FIG. 14. In this
example, for expansion in a range of 90 mm to 96 mm, the 19 mm cage
is post-packed with three inserts 56, as shown in FIG. 14. In this
example, for expansion in a range of 97 mm to 108 mm, the 19 mm
cage is post-packed with two inserts 56, as shown in FIG. 14, and
one insert 56, as shown in FIG. 15.
[0064] In one example, cage 12 has a mean diameter of 22 mm and is
pre-packed with an insert 52, similar those shown in FIGS. 5 and 6.
The 22 mm cage can include various alternate height dimensions, for
example, a collapsed height of 21 mm that can be expanded to a
height of 26 mm, and a collapsed height of 25 mm that can be
expanded to a height of 33 mm. In this example, the 22 mm cage is
not post-packed with insert 56.
[0065] In one example, cage 12 has a mean diameter of 22 mm, is
pre-packed with an insert 52, similar those shown in FIGS. 5 and 6,
and has a collapsed height of 31 mm that can be expanded in a range
to a height of 41 mm. In this example, for expansion in a range of
31 mm to 37 mm, the 22 mm cage is not post-packed with insert 56.
In this example, for expansion in a range of 38 mm to 41 mm, the 22
mm cage is post-packed with insert 56, as shown in FIG. 14.
[0066] In one example, cage 12 has a mean diameter of 22 mm, is
pre-packed with an insert 52, similar those shown in FIGS. 5 and 6,
and has a collapsed height of 37 mm that can be expanded in a range
to a height of 53 mm. In this example, for expansion in a range of
37 mm to 43 mm, the 22 mm cage is not post-packed with insert 56.
In this example, for expansion in a range of 44 mm to 49 mm, the 22
mm cage is post-packed with insert 56, as shown in FIG. 14. In this
example, for expansion in a range of 50 mm to 53 mm, the 22 mm cage
is post-packed with insert 56, as shown in FIG. 7.
[0067] In one example, cage 12 has a mean diameter of 22 mm, is
pre-packed with an insert 52, similar those shown in FIGS. 5 and 6,
and has a collapsed height of 48 mm that can be expanded in a range
to a height of 75 mm. In this example, for expansion in a range of
48 mm to 54 mm, the 22 mm cage is not post-packed with insert 56.
In this example, for expansion in a range of 55 mm to 58 mm, the 22
mm cage is post-packed with insert 56, as shown in FIG. 14. In this
example, for expansion in a range of 59 mm to 61 mm, the 22 mm cage
is post-packed with insert 56, as shown in FIG. 15. In this
example, for expansion in a range of 62 mm to 68 mm, the 22 mm cage
is post-packed with insert 56, as shown in FIG. 6, and insert 56,
as shown in FIG. 14. In this example, for expansion in a range of
69 mm to 75 mm, the 22 mm cage is post-packed with two inserts 56,
as shown in FIG. 7.
[0068] In one example, cage 12 has a mean diameter of 22 mm, is
pre-packed with an insert 52, similar those shown in FIGS. 5 and 6,
and has a collapsed height of 68 mm that can be expanded in a range
to a height of 107 mm. In this example, for expansion in a range of
68 mm to 75 mm, the 22 mm cage is not post-packed with insert 56.
In this example, for expansion in a range of 76 mm to 79 mm, the 22
mm cage is post-packed with insert 56, as shown in FIG. 14. In this
example, for expansion in a range of 80 mm to 82 mm, the 22 mm cage
is post-packed with insert 56, as shown in FIG. 15. In this
example, for expansion in a range of 83 mm to 89 mm, the 22 mm cage
is post-packed with insert 56, as shown in FIG. 7, and insert 56,
as shown in FIG. 14. In this example, for expansion in a range of
90 mm to 96 mm, the 22 mm cage is post-packed with two inserts 56,
as shown in FIG. 7. In this example, for expansion in a range of 97
mm to 107 mm, the 22 mm cage is post-packed with two inserts 56, as
shown in FIG. 7, and one insert 56, as shown in FIG. 14.
[0069] In one example, cage 12 has a mean diameter of 25 mm and is
pre-packed with an insert 52, similar those shown in FIGS. 5 and 6.
The 25 mm cage can include various alternate height dimensions, for
example, a collapsed height of 21 mm that can be expanded to a
height of 26 mm, and a collapsed height of 25 mm that can be
expanded to a height of 33 mm. In this example, the 25 mm cage is
not post-packed with insert 56.
[0070] In one example, cage 12 has a mean diameter of 25 mm, is
pre-packed with an insert 52, similar those shown in FIGS. 5 and 6,
and has a collapsed height of 31 mm that can be expanded in a range
to a height of 41 mm. In this example, for expansion in a range of
31 mm to 38 mm, the 25 mm cage is not post-packed with insert 56.
In this example, for expansion in a range of 39 mm to 41 mm, the 25
mm cage is post-packed with insert 56, as shown in FIG. 14.
[0071] In one example, cage 12 has a mean diameter of 25 mm, is
pre-packed with an insert 52, similar those shown in FIGS. 5 and 6,
and has a collapsed height of 37 mm that can be expanded in a range
to a height of 53 mm. In this example, for expansion in a range of
37 mm to 44 mm, the 25 mm cage is not post-packed with insert 56.
In this example, for expansion in a range of 45 mm to 50 mm, the 25
mm cage is post-packed with insert 56, as shown in FIG. 14. In this
example, for expansion in a range of 50 mm to 53 mm, the 25 mm cage
is post-packed with two inserts 56, as shown in FIG. 14.
[0072] In one example, cage 12 has a mean diameter of 25 mm, is
pre-packed with an insert 52, similar those shown in FIGS. 5 and 6,
and has a collapsed height of 48 mm that can be expanded in a range
to a height of 75 mm. In this example, for expansion in a range of
48 mm to 55 mm, the 25 mm cage is not post-packed with insert 56.
In this example, for expansion in a range of 56 mm to 62 mm, the 25
mm cage is post-packed with insert 56, as shown in FIG. 14. In this
example, for expansion in a range of 63 mm to 69 mm, the 25 mm cage
is post-packed with insert 56, as shown in FIG. 14, and insert 56,
as shown in FIG. 15. In this example, for expansion in a range of
70 mm to 75 mm, the 25 mm cage is post-packed with two inserts 56,
as shown in FIG. 14, and one insert 56, as shown in FIG. 15.
[0073] In one example, cage 12 has a mean diameter of 25 mm, is
pre-packed with an insert 52, similar those shown in FIGS. 5 and 6,
and has a collapsed height of 68 mm that can be expanded in a range
to a height of 107 mm. In this example, for expansion in a range of
68 mm to 75 mm, the 25 mm cage is not post-packed with insert 56.
In this example, for expansion in a range of 76 mm to 82 mm, the 25
mm cage is post-packed with insert 56, as shown in FIG. 14. In this
example, for expansion in a range of 83 mm to 90 mm, the 25 mm cage
is post-packed with insert 56, as shown in FIG. 14, and insert 56,
as shown in FIG. 15. In this example, for expansion in a range of
90 mm to 98 mm, the 25 mm cage is post-packed with insert 56, as
shown in FIG. 7, and insert 56, as shown in FIG. 14. In this
example, for expansion in a range of 99 mm to 107 mm, the 25 mm
cage is post-packed with two inserts 56, as shown in FIG. 14, and
two inserts 56, as shown in FIG. 15.
[0074] Cage 12 engages and spaces apart opposing endplate surfaces
E1, E2 and is secured within vertebral space S to stabilize and
immobilize portions of vertebrae V in connection with bone growth
for fusion and fixation of vertebrae V1, V2. Fixation of implant 20
with endplate surfaces E1, E2 may be facilitated by the resistance
provided by the joint space and/or engagement with endplate
surfaces E1, E2.
[0075] In some embodiments, cage 12 may engage only one endplate.
Components of spinal implant system 10 including cage 12 can be
delivered or implanted as a pre-assembled device or can be
assembled in situ. Components of spinal implant system 10 including
cage 12 may be completely or partially revised, removed or replaced
in vivo. In some embodiments, one or all of the components of
spinal implant system 10 can be delivered to the surgical site via
mechanical manipulation and/or a free hand technique.
[0076] In one embodiment, cage 12 may include fastening elements,
which may include locking structure, configured for fixation with
vertebrae V1, V2 to secure joint surfaces and provide complementary
stabilization and immobilization to a vertebral region. In some
embodiments, locking structure may include fastening elements such
as, for example, rods, plates, clips, hooks, adhesives and/or
flanges. In some embodiments, spinal implant system 10 can be used
with screws to enhance fixation. In some embodiments, spinal
implant system 10 and any screws and attachments may be coated with
an agent, similar to those described herein, for enhanced bony
fixation to a treated area. The components of spinal implant system
10 can be made of radiolucent materials such as polymers.
Radiomarkers may be included for identification under x-ray,
fluoroscopy, CT or other imaging techniques.
[0077] In one embodiment, spinal implant system 10 includes a
plurality of cages 12. In some embodiments, employing a plurality
of cages 12 can optimize the amount vertebral space S can be spaced
apart such that the joint spacing dimension can be preselected. The
plurality of cages 12 can be oriented in a side by side engagement,
spaced apart and/or staggered.
[0078] In some embodiments, the use of microsurgical and image
guided technologies may be employed to access, view and repair
spinal deterioration or damage, with the aid of spinal implant
system 10. Upon completion of the procedure, the non-implanted
components, surgical instruments and assemblies of spinal implant
system 10 are removed and the incision is closed.
[0079] It will be understood that various modifications may be made
to the embodiments disclosed herein. Therefore, the above
description should not be construed as limiting, but merely as
exemplification of the various embodiments. Those skilled in the
art will envision other modifications within the scope and spirit
of the claims appended hereto.
* * * * *